Coping with outpatients who cannot cope : management of persistent complainers in an African country

Some 15 to 20% of patients visiting general outpatient services in developing countries suffer from some emotional disorder although they present mainly with somatic complaints. Their contact with the services is generally a frustrating experience for themselves and for the health worker, resulting in undue medical attention to their problem. A series of five consecutive steps, of increasing psychiatric sophistication, to assist in the management of these cases is described, permitting the health worker to stop at a level not exceeding his competence.